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1. Mrs. https://quizlet.com/_dgbewk
Burton is a retiree with substantial income. She is enrolled in an MA-PD
plan and was disappointed with the service she received from her primary
care physician because she was told she would have to wait five weeks to get
an appointment when she was feeling ill. She called you to ask what she could
do so she would not have to put up with such poor access to care. What could
you tell her?: She could file a grievance with her plan to complain about the lack of
timeliness in getting an appointment.
2. Edward IP suffered from serious kidney disease. As a result. Edward be-
came eligible for Medicare coverage due to end-stage renal disease (ESRD).
A close relative donated their kidney and Edward successfully underwent
transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will continue, what should you say?: Individuals eligible for
Medicare based on ESRD generally lose eligibility 36 months after the month in
which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward may, however, remain enrolled in
Part B but solely for coverage of immunosuppressive drugs if he has no other health
care coverage that would cover the drugs.
3. Mildred Savage enrolled in Allcare Medicare Advantage plan several years
ago. Mildred recently learned that she is suffering from inoperable cancer and
has just a few months to live. She would like to spend these final months in
hospice care. Mildred's family asks you whether hospice benefits will be paid
for under the Allcare Medicare Advantage plan. What should you say?: Mildred
may remain enrolled in Allcare and make a hospice election. Hospice benefits will
be paid for by Original Medicare under Part A and Allcare will continue to pay for
any non-hospice services.
4. Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible and
wants to know how much he will have to pay. What should you tell him?: Mr.
Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
5. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand what coverage Medicare Supplemental Insurance provides since his
health care needs are different from his wife's needs. What could you tell Mr.
Moy?: Medicare Supplemental Insurance would help cover his Part A and Part B
deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as
possibly some services that Medicare does not cover.
6. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is concerned
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that she will not qualify for coverage under part A because she was not born in
the United States. What should you tell her?: Most individuals who are citizens
and age 65 or over are covered under Part A by virtue of having paid Medicare
taxes while working, though some may be covered as a result of paying monthly
premiums.
7. Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-
abled by the Social Security Administration and has been receiving disability
payments. He is wondering whether he can obtain coverage under Medicare.
What should you tell him?: After receiving such disability payments for 24 months,
he will be automatically enrolled in Medicare, regardless of age.
8. Mr. Xi will soon turn age 65 and has come to you for advice as to what
services are provided under Original Medicare. What should you tell Mr. Xi that
best describes the health coverage provided to Medicare beneficiaries?: Ben-
eficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots.
9. Mrs. Pea H is 66 years old, has coverage under an employer plan, and will retire
next year. She heard she must enroll in Part B at the beginning of the year to
ensure no gap in coverage. What can you tell her?: She may enroll at any time
while she is covered under her employer plan, but she will have a special eight-month
enrollment period after the last month on her employer plan that differs from the
standard general enrollment period, during which she may enroll in Medicare Part
B.
10. Mr. Davis is 52 years old and has recently been diagnosed with end-stage
renal disease (ESRD) and will soon begin dialysis. He is wondering if he can
obtain coverage under Medicare. What should you tell him?: He may sign-up
for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
11. Madeline Martinez was widowed several years ago. Her husband worked
for many years and contributed into the Medicare system. He also left a
substantial estate which provides Madeline with an annual income of approx-
imately $130,000. Madeline, who has only worked part-time for the last three
years, will soon turn age 65 and hopes to enroll in Original Medicare. She
comes to you for advice. What should you tell her?: You should tell Madeline
that she will be able to enroll in Medicare Part A without paying monthly premiums
due to her husband's long work record and participation in the Medicare system.
You should also tell Madeline that she will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due her substantial income.
12. Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
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for 40 https://quizlet.com/_dgbewk
years and paying Medicare taxes. What should you tell her?: To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
13. To obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.: Mrs. Gonzalez cannot
purchase a Medigap plan that covers drugs, but she could keep her Medigap policy
and enroll in a Part D prescription drug plan.
14. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur-
rently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare
Supplement (Medigap) plan which he has had for several years. However, the
plan does not provide drug benefits. How would you advise Agent John Miller
to proceed?: Tell prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
15. Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellent health and will have considerable income when she retires. She
is concerned that her income will make it impossible for her to qualify for
Medicare. What could you tell her to address her concern?: Medicare is a
program for people age 65 or older and those under age 65 with certain disabilities,
end-stage renal disease, and Lou Gehrig's disease so she will be eligible for
Medicare.
16. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and
a Medigap plan to pick up costs not covered by that plan. What should you tell
him?: It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an
MA plan, and besides, Medigap only works with Original Medicare.
17. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance?: She should contact her state
Medicaid agency to see if she qualifies for one of several programs that can help
with Medicare costs for which she is responsible.
18. Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare. What could you tell
him?: Part A, which covers hospital, skilled nursing facility, hospice, and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
19. Mr. Wu is eligible for Medicare. He has limited financial resources but failed
to qualify for the Part D low-income subsidy. Where might he turn for help with
his prescription drug costs?: Mr. Wu may still qualify for help in paying Part D
costs through his State Pharmaceutical Assistance Program.
20. Shirly Thomas was enrolled in Medicaid during the Public Health Emer-
gency (PHE). This coverage has recently been terminated due to the end of
, AHIP
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the https://quizlet.com/_dgbewk
PHE. While Shirley
was enrolled in Medicaid, she missed an opportunity
to enroll in Medicare and now wants Part B. Which of the following statements
best describes Shirley's ability to now enroll in Medicare Part B?: Shirley is eli-
gible for a Special Enrollment Period (SEP) for up to six months after the termination
of her Medicaid coverage. Under this SEP, Shirley can choose retroactive coverage
back to the date of termination from Medicaid or coverage beginning the month after
the month of enrollment.
21. Anthony Boniface turned 65 in 2023. He was not receiving Social Security
or Railroad Retirement Benefits on his 65th birthday. He was interested in
obtaining Medicare coverage and is eligible for premium-free Part A. Before he
could enroll in Medicare, his entire area was impacted by a hurricane causing
massive flooding and severe wind damage. The Federal government declared
this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can
now obtain Medicare coverage. What should you say?: Anthony is eligible for
a special enrollment period (SEP) because he missed an enrollment period due to
the impact of the Federally declared disaster. This SEP will allow Anthony to enroll
in Part B up to six months after the end of the emergency declaration. Anthony may
enroll in premium-free Part A at any time and his Part A coverage will be retroactive
for up to 6 months.
22. Mrs. Lyons is in good health, uses a single prescription, and lives indepen-
dently in her own home. She is attracted by the idea of maintaining control
over a Medical Savings Account (MSA) but is not sure if the plan associated
with the account will fit her needs. What specific piece of information about a
Medicare MSA plan would it be important for her to know, prior to enrolling in
such a plan?: All MSAs cover Part A and Part B benefits, but not Part D prescription
drug benefits, which could be obtained by also enrolling in a separate prescription
drug plan.
23. Mrs. Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care. What should you tell
her?: Mrs. Ramos can obtain care from any provider who participates in Original
Medicare, but generally will have a higher cost-sharing amount if she sees a provider
who/that is not a part of the PPO network.
24. Mr. Romero is 64, retiring soon, and considering enrollment in his em-
ployer-sponsored retiree group health plan that includes drug coverage with
nominal copays. He heard about a neighbor's MA-PD plan that you represent
and because he takes numerous prescription drugs, he is considering signing
up for it. What should you tell him?: He should compare the benefits in his em-
ployer-sponsored retiree group health plan with the benefits in his neighbor's MA-PD
Study online at
1. Mrs. https://quizlet.com/_dgbewk
Burton is a retiree with substantial income. She is enrolled in an MA-PD
plan and was disappointed with the service she received from her primary
care physician because she was told she would have to wait five weeks to get
an appointment when she was feeling ill. She called you to ask what she could
do so she would not have to put up with such poor access to care. What could
you tell her?: She could file a grievance with her plan to complain about the lack of
timeliness in getting an appointment.
2. Edward IP suffered from serious kidney disease. As a result. Edward be-
came eligible for Medicare coverage due to end-stage renal disease (ESRD).
A close relative donated their kidney and Edward successfully underwent
transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will continue, what should you say?: Individuals eligible for
Medicare based on ESRD generally lose eligibility 36 months after the month in
which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward may, however, remain enrolled in
Part B but solely for coverage of immunosuppressive drugs if he has no other health
care coverage that would cover the drugs.
3. Mildred Savage enrolled in Allcare Medicare Advantage plan several years
ago. Mildred recently learned that she is suffering from inoperable cancer and
has just a few months to live. She would like to spend these final months in
hospice care. Mildred's family asks you whether hospice benefits will be paid
for under the Allcare Medicare Advantage plan. What should you say?: Mildred
may remain enrolled in Allcare and make a hospice election. Hospice benefits will
be paid for by Original Medicare under Part A and Allcare will continue to pay for
any non-hospice services.
4. Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible and
wants to know how much he will have to pay. What should you tell him?: Mr.
Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
5. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand what coverage Medicare Supplemental Insurance provides since his
health care needs are different from his wife's needs. What could you tell Mr.
Moy?: Medicare Supplemental Insurance would help cover his Part A and Part B
deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as
possibly some services that Medicare does not cover.
6. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is concerned
, AHIP
Study online at
https://quizlet.com/_dgbewk
that she will not qualify for coverage under part A because she was not born in
the United States. What should you tell her?: Most individuals who are citizens
and age 65 or over are covered under Part A by virtue of having paid Medicare
taxes while working, though some may be covered as a result of paying monthly
premiums.
7. Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-
abled by the Social Security Administration and has been receiving disability
payments. He is wondering whether he can obtain coverage under Medicare.
What should you tell him?: After receiving such disability payments for 24 months,
he will be automatically enrolled in Medicare, regardless of age.
8. Mr. Xi will soon turn age 65 and has come to you for advice as to what
services are provided under Original Medicare. What should you tell Mr. Xi that
best describes the health coverage provided to Medicare beneficiaries?: Ben-
eficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots.
9. Mrs. Pea H is 66 years old, has coverage under an employer plan, and will retire
next year. She heard she must enroll in Part B at the beginning of the year to
ensure no gap in coverage. What can you tell her?: She may enroll at any time
while she is covered under her employer plan, but she will have a special eight-month
enrollment period after the last month on her employer plan that differs from the
standard general enrollment period, during which she may enroll in Medicare Part
B.
10. Mr. Davis is 52 years old and has recently been diagnosed with end-stage
renal disease (ESRD) and will soon begin dialysis. He is wondering if he can
obtain coverage under Medicare. What should you tell him?: He may sign-up
for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
11. Madeline Martinez was widowed several years ago. Her husband worked
for many years and contributed into the Medicare system. He also left a
substantial estate which provides Madeline with an annual income of approx-
imately $130,000. Madeline, who has only worked part-time for the last three
years, will soon turn age 65 and hopes to enroll in Original Medicare. She
comes to you for advice. What should you tell her?: You should tell Madeline
that she will be able to enroll in Medicare Part A without paying monthly premiums
due to her husband's long work record and participation in the Medicare system.
You should also tell Madeline that she will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due her substantial income.
12. Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
, AHIP
Study online at
for 40 https://quizlet.com/_dgbewk
years and paying Medicare taxes. What should you tell her?: To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
13. To obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.: Mrs. Gonzalez cannot
purchase a Medigap plan that covers drugs, but she could keep her Medigap policy
and enroll in a Part D prescription drug plan.
14. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur-
rently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare
Supplement (Medigap) plan which he has had for several years. However, the
plan does not provide drug benefits. How would you advise Agent John Miller
to proceed?: Tell prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
15. Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellent health and will have considerable income when she retires. She
is concerned that her income will make it impossible for her to qualify for
Medicare. What could you tell her to address her concern?: Medicare is a
program for people age 65 or older and those under age 65 with certain disabilities,
end-stage renal disease, and Lou Gehrig's disease so she will be eligible for
Medicare.
16. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and
a Medigap plan to pick up costs not covered by that plan. What should you tell
him?: It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an
MA plan, and besides, Medigap only works with Original Medicare.
17. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance?: She should contact her state
Medicaid agency to see if she qualifies for one of several programs that can help
with Medicare costs for which she is responsible.
18. Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare. What could you tell
him?: Part A, which covers hospital, skilled nursing facility, hospice, and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
19. Mr. Wu is eligible for Medicare. He has limited financial resources but failed
to qualify for the Part D low-income subsidy. Where might he turn for help with
his prescription drug costs?: Mr. Wu may still qualify for help in paying Part D
costs through his State Pharmaceutical Assistance Program.
20. Shirly Thomas was enrolled in Medicaid during the Public Health Emer-
gency (PHE). This coverage has recently been terminated due to the end of
, AHIP
Study online at
the https://quizlet.com/_dgbewk
PHE. While Shirley
was enrolled in Medicaid, she missed an opportunity
to enroll in Medicare and now wants Part B. Which of the following statements
best describes Shirley's ability to now enroll in Medicare Part B?: Shirley is eli-
gible for a Special Enrollment Period (SEP) for up to six months after the termination
of her Medicaid coverage. Under this SEP, Shirley can choose retroactive coverage
back to the date of termination from Medicaid or coverage beginning the month after
the month of enrollment.
21. Anthony Boniface turned 65 in 2023. He was not receiving Social Security
or Railroad Retirement Benefits on his 65th birthday. He was interested in
obtaining Medicare coverage and is eligible for premium-free Part A. Before he
could enroll in Medicare, his entire area was impacted by a hurricane causing
massive flooding and severe wind damage. The Federal government declared
this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can
now obtain Medicare coverage. What should you say?: Anthony is eligible for
a special enrollment period (SEP) because he missed an enrollment period due to
the impact of the Federally declared disaster. This SEP will allow Anthony to enroll
in Part B up to six months after the end of the emergency declaration. Anthony may
enroll in premium-free Part A at any time and his Part A coverage will be retroactive
for up to 6 months.
22. Mrs. Lyons is in good health, uses a single prescription, and lives indepen-
dently in her own home. She is attracted by the idea of maintaining control
over a Medical Savings Account (MSA) but is not sure if the plan associated
with the account will fit her needs. What specific piece of information about a
Medicare MSA plan would it be important for her to know, prior to enrolling in
such a plan?: All MSAs cover Part A and Part B benefits, but not Part D prescription
drug benefits, which could be obtained by also enrolling in a separate prescription
drug plan.
23. Mrs. Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care. What should you tell
her?: Mrs. Ramos can obtain care from any provider who participates in Original
Medicare, but generally will have a higher cost-sharing amount if she sees a provider
who/that is not a part of the PPO network.
24. Mr. Romero is 64, retiring soon, and considering enrollment in his em-
ployer-sponsored retiree group health plan that includes drug coverage with
nominal copays. He heard about a neighbor's MA-PD plan that you represent
and because he takes numerous prescription drugs, he is considering signing
up for it. What should you tell him?: He should compare the benefits in his em-
ployer-sponsored retiree group health plan with the benefits in his neighbor's MA-PD
